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Biomedical subjects

R J Leo

Publications and source records attributed to R J Leo.

17 recordsLinked to original sources
PubMed1998

Referral patterns and recognition of depression among African-American and Caucasian patients.

A retrospective review of psychiatric consultations was conducted for African-American and Caucasian patients for a 2-year period. Reasons for referral, assigned diagnoses, accuracy rates, and discordance and concordance rates were assessed. Referrals for depression comprised 24.6% of all consults for Caucasian and African-American inpatients. Only 40.3% of patients referred for depression were diagnosed with a depressive disorder; 54.4% of patients diagnosed with depressive disorders were referred for other reasons. African-American patients were referred for evaluation of depression and diagnosed with depressive disorders significantly less often than Caucasian patients. No significant differences were obtained between African-Americans and Caucasians in the accuracy rates of patients referred for depression. Discordance and concordance rates for the two groups were comparable. Diagnoses assigned to African-Americans and Caucasians incorrectly referred for depression did not differ significantly. For depressed African-Americans and Caucasians referred for reasons other than depression, the only difference noted was in the referral rates for adjustment of psychotropics. The nonpsychiatric staff fails to recognize depression and often refer depressed patients inappropriately. Depressed patients are primarily referred for suicide assessment and disruptive behaviors. Referrals for depression may be a secondary concern to nonpsychiatric staff. In addition, cultural variables and racial differences between hospital staff and patients may account for the differences in referral patterns. Awareness of the needs of African-American patients is required.

Black or African American↗
PubMed1998

Psychosis associated with hypopituitarism.

Psychosis is one of many possible psychiatric disturbances associated with endocrinologic abnormalities. Previous reports linking psychosis with hypopituitarism have been limited. Furthermore, such reports suggested that the psychotic symptoms were more accurately part of a delirium. We report two patients with hypopituitarism who presented with psychotic symptoms, in the absence of an altered sensorium. They were assigned functional psychiatric diagnoses on initial presentation. Their symptoms abated after correction of underlying hormonal abnormalities. The evaluation and treatment of psychiatric disturbances associated with hypopituitarism are discussed.

Adult↗
PubMed1997

Geropsychiatric consultation for African-American and Caucasian patients.

We assessed differences in the referral rates of African-American and Caucasian elderly for geropsychiatric consultation. Reasons for referral, assigned diagnoses, and interventions made were also compared. A retrospective chart review of psychiatric consultations was completed for patients aged 65 years and older for a 2-year period. Significantly more consultations were requested Caucasian elderly (6.2%) than for African-American elderly (3.8%). African-American elderly were referred for evaluation of psychosis significantly more often and for assessment of suicide potential significantly less often than Caucasians. Consultants diagnosed African-American elderly with psychotic disorders, specifically schizophrenia, and dementia significantly more often than Caucasians. Caucasian elderly were significantly more often diagnosed with mood disorders, especially depressive disorders. Interventions/recommendations made for Caucasian and African-American elderly did not differ for the most part. Recommendations for legal measures were suggested for African-American elderly more often than for Caucasians. Differences between Caucasian and African-American elderly were observed in consultation referral rates, reasons for referral, and psychiatric diagnoses made. The potential impact of cultural variables and the racial and age differences between hospital staff and patients may account for some of these findings. Further awareness of the needs of African-American elderly is required.

Black or African American↗
PubMed1997

Utility of thyroid function screening in adolescent psychiatric inpatients.

OBJECTIVE: Thyroid function abnormalities have been associated with psychiatric symptoms. This study examines the utility of thyroid screening among adolescent psychiatric inpatients. METHOD: A retrospective chart review of 196 first-time admissions to an adolescent psychiatric unit was conducted. Charts were screened for demographics, presence/absence of thyroid function testing, history of thyroid disease, medication/illicit substance use, and other factors of influence on thyroid testing. Thyroid test results were reviewed for abnormalities. RESULTS: Thyroid function testing was conducted in 150 of the 196 admissions. Fifty-two patients had abnormalities, most of which were isolated abnormalities of thyroxine (T4) or triiodothyronine uptake (T3U). Laboratory diagnosis of hyperthyroidism and mild hypothyroidism was met by two and eight patients, respectively; five had profiles that were normal upon subsequent testing 1 week later. None of the patients was symptomatic, and none required thyroid supplementation or antithyroid medications. Gender differences in T4 and T3U were noted, and age was positively correlated with T3U. CONCLUSIONS: Thyroid function tests may be spuriously abnormal in routine screening of newly admitted psychiatric patients. Routine thyroid screening among adolescent psychiatric inpatients is unwarranted except in patients who display physical signs or symptoms suggestive of thyroid disease.

Adolescent↗
PubMed1996

Cardiomyopathy associated with clozapine.

OBJECTIVE: To report a case of symptomatic cardiomyopathy induced during treatment with clozapine, an antipsychotic of the dibenzodiazepine class. CASE SUMMARY: A patient with a long psychiatric history significant for schizophrenia and no prior cardiac history developed dyspnea, malaise, and edema with a low ventricular ejection fraction during clozapine therapy. DISCUSSION: The literature concerning cardiorespiratory complications with clozapine therapy is reviewed. CONCLUSIONS: Cardiorespiratory complications associated with clozapine use are rare. Caution may be warranted in patients treated with other medications, such as benzodiazepines, and in patients with underlying cardiac disease.

Adult↗
PubMed1996

Movement disorders associated with the serotonin selective reuptake inhibitors.

BACKGROUND: To review the case reports and case series of movement disorders ascribed to the use of serotonin selective reuptake inhibitors (SSRIs). METHOD: Reports of SSRI-induced extrapyramidal symptoms (EPS) in the literature were located using a MEDLINE search and review of bibliographies. RESULTS: Among the 71 cases of SSRI-induced EPS reported in the literature, the most common side effect was akathisia (45.1%), followed by dystonia (28.2%), parkinsonism (14.1%), and tardive dyskinesia-like states (11.3%). Among patients with Parkinson's disease treated with SSRIs, there were 16 cases of worsening parkinsonism. Patients who developed dystonia, parkinsonism, or tardive dyskinesia were older on average than patients with akathisia; 67.6% of affected patients were females. Fluoxetine, the most commonly prescribed SSRI to date, was implicated in 53 (74.6%) of cases of SSRI-induced EPS. Several reports (57.7%) were confounded by the concomitant use of other medications that can contribute to the development of EPS. CONCLUSION: SSRI-induced EPS are probably related to agonism of serotonergic input to dopaminergic pathways within the CNS. Several patient-dependent and pharmacokinetic variables may determine the likelihood that EPS will emerge. Although these side effects are infrequent, clinicians should be alert to the possibility of their occurrence.

1-Naphthylamine↗
PubMed1995

Clomipramine treatment of paraphilias in elderly demented patients.

Sexually inappropriate conduct often accompanies the disinhibition associated with dementia and neuropsychologic deficits. Management of these behaviors is problematic and time consuming. We report two cases in which paraphilias responded to treatment with clomipramine. This effect was not due to the sexual side effects of the drug (e.g., decreased ability to sustain an erection or orgasm). Careful monitoring of the elderly patient is required during treatment with clomipramine, particularly with regard to orthostasis, the increased risk of falls, and worsened confusion secondary to the potential risks of anticholinergic delirium and toxicity.

Age of Onset↗
PubMed1995

Parkinsonism associated with fluoxetine and cimetidine: a case report.

Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) are effective for the treatment of depression in the elderly and offer a safer side-effect profile as compared to tricyclics and monoamine oxidase inhibitors. We report a case in which a patient treated with fluoxetine developed parkinsonism following the introduction of cimetidine. Inhibition of hepatic P450 cytochrome enzymes by cimetidine with an increase in serum levels of norfluoxetine may have precipitated this extrapyramidal syndrome, which has been related to agonism of the serotonergic input to nigrostriatal tracts and basal ganglia. Parkinsonism as a side effect of SSRIs occurs infrequently, suggesting an idiosyncratic response resulting from a functional imbalance of serotonergic and dopaminergic activity in susceptible individuals. Careful monitoring of geriatric patients treated with fluoxetine is indicated, particularly for those on high doses, those with impaired hepatic functioning, or those treated with concurrent medications that slow the metabolism of fluoxetine.

Aged↗
PubMed1991

Seizure activity associated with imipenem use: clinical case reports and review of the literature.

Two patients with multiple organ systems failure developed seizures after receiving imipenem/cilastatin (I/C) despite dose adjustment for poor renal function. Neither patient had a past history of seizures, nor had experienced seizures after receiving high doses of other beta-lactam antibiotics. Simple dose adjustment of I/C based on low creatinine clearances may not be adequate to prevent seizures.

Aged↗
PubMed1986

Effects of hypothalamic knife cuts and experience on maternal behavior in the rat.

Recent investigations suggest that the disruption of placentophagia, pup-directed maternal behavior, and nestbuilding seen after lesions of the medial preoptic area (MPO) or the lateral hypothalamus may be due to the interruption at different points of a single longitudinal neural system mediating these behaviors. To test this, we compared the effects of knife cuts on the lateral border of the MPO, and of the posterior medial forebrain bundle (MFB), with asymmetrical cuts combining a unilateral MPO cut with a contralateral MFB cut. We observed placentophagia, nestbuilding, and pup-directed maternal behaviors at, and after, parturition in both primiparous and biparous rats. In primiparae, MPO cuts (a) disrupted placentophagia, (b) delayed the onset of crouching and pup-licking, and (c) eliminated retrieval and nestbuilding. MFB cuts (a) disrupted placentophagia, (b) delayed the onset of maternal behavior, and (c) eliminated nestbuilding. Asymmetrical cuts (a) disrupted placentophagia, and (b) delayed the onset of maternal behavior. In biparous rats, MPO cuts eliminated nestbuilding and retrieval. MFB cuts (a) disrupted placentophagia, and (b) eliminated nestbuilding. Asymmetrical cuts (a) delayed nestbuilding. These results suggest the involvement of a longitudinal neural system in the production of immediate pup-directed maternal behavior, placentophagia, and nestbuilding in parturient primiparae, but which is not critical for the eventual display of maternal behavior and nestbuilding in maternally naive rats, nor for the immediate onset of placentophagia and maternal behavior in maternally experienced rats.

Animals↗